Some physiatrists have developed a boutique practice in analyzing, reprogramming, and refilling
implanted Lioresal (generic name is Baclofen) Pumps. CPT coding changes effective
January 1, 2012 no longer split the “Refill” and the “Reprogramming” when done together.
A list of CPT Coding for Lioresal Pump Management follows:

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Approx
Medicare-2015
CPT Code CPT Summary Description Allowed
95990 Refill & maintenance ONLY with or without 90
Analysis, no reprogramming (by Non-physician)

95991 Refill & maintenance ONLY with or without 120
Analysis, no reprogramming (by Physician)
————————————————————————————————————-
62367 Analysis, no Reprogramming, 40
no Refill

62368 Analysis + Reprogramming, no Refill 60
————————————————————————————————————-
62369 Analysis + Reprogramming + Refill 120
(performed by Non-physician)

62370 Analysis + Reprogramming + Refill 130
(performed by Physician)

Examples for Coders/Billers
If a physician performs the Refill alone, no Analysis, no Reprogramming, then code 95991.
If a physician performs the Refill + Analysis, no Reprogramming, then STILL code 95991.
If a physician performs the Analysis, no Reprogramming, no Refill, then code 62367.
If a physician performs the Analysis + Reprogramming, no Refill, then code 62368.
If a physician performs the Refill + Analysis + Reprogramming, then code 62370.

Lioresal Medication – J0475
Lioresal medication is EXTREMELY expensive, and can cost from $200 to $1600 per visit. It is
important to bill the correct quantities of the J0475 code to obtain the correct insurance
reimbursement. Since the billings to Medicare must be reported as units, the correct drug code
must be converted to the correct number of units. The 2015 Medicare allowed amount for CPT
J0475 is approximately $210 per unit, which may assist you in converting the medication to units.
An incorrect conversion to units can easily cost the practice thousands of dollars. As it relates to
practice income, the profit on the medication is small, barring any appreciable discount from
Medtronic.

Summary
A physiatry practice can make good income from the procedures related to analyzing,
reprogramming, and refilling implanted Lioresal pumps, along with a small income from
billing the medication itself.

Contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482, www.physiatrymedicalbilling.com, [email protected]

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